The neoliberal university and progressive neoliberalism

Traditionally at least, universities and HEIs have retained a largely positive public image, encapsulated by a pedagogical culture which endorses open learning and theoretically informed democratic debate; as well as innovative research and free thinking, set alongside a tendency to encourage moral and social enlightenment. Idealistic or not, this reputation can appear as somewhat remote within the confines of the market-driven, neoliberal or ‘corporate university’. Several studies, for example, have highlighted how scholarship and pedagogy are increasingly corrupted by the commodification of learning within ever-more business-orientated teaching and research sectors (Ball, Reference Ball2012, Reference Ball2015). This has included the growth of an administrative and surveillance-heavy culture that prioritises targets, bureaucracy, monitoring, short-term goals and the casualisation of employment, which have led to a burgeoning class of precariat academics, researchers and other staff (Berg et al., Reference Berg, Huijbens and Larsen2016; Curtis, Reference Curtis2016). Fierce competition between institutions, academics and researchers can also reinforce traditional forms of inequality and exclusion based on age, class, gender and ethnicity, among other categories (Deem et al., Reference Deem, Morley and Tlili2005; Granleese and Sayer, Reference Granleese and Sayer2006; Acker and Wagner, Reference Acker and Wagner2019; Lund, Reference Lund2020; Wellcome Trust, 2020).

For some at least, the relatively swift adoption of market and business principles and practices in sectors such as universities has been supported by a unique hegemonic driver. For example, Nancy Fraser (Reference Fraser2019) has highlighted the emergence and wider social and political influence of what she terms ‘progressive neoliberalism’. This ideological endeavour includes the eclipse of material redistribution by recognition, in tandem with a political-economic project that can engage ‘with several different and even competing projects of recognition – including progressive ones’ (Fraser, Reference Fraser2019: 12–14). According to Fraser (Reference Fraser2019), a dynamic and evolving discourse of neoliberalism has actively engaged with yet adapted progressive ideals, including those drawn from feminism, multiculturalism, environmentalism, age, disability, gay and transsexual-related rights, among others. This includes greater recognition being given rhetorically and, in part through policy mandates, to otherwise excluded or disenfranchised social groups. Through often calculated attention given to identity and recognition-related issues, financially driven neoliberalism has merged with progressivism to develop a ‘hegemonic bloc’ in Gramsci's (1971) understanding, or dominant ruling alliance based around ideas, social relations and institutions. Social order and consent among the wider population has been strengthened for ruling elites through the partial acceptance and promotion of progressive political ideals and concepts which previously would have been confined to ‘identity politics’ supported by minority groups. However, according to Fraser, this restricted integration of progressive ideals to reset the neoliberal hegemonic bloc with new leftist constructs has ultimately been used to extend the free market further:

Progressive discourses from civil society were raided by political elites and subsequently repackaged ideologically through government, institutional and professional narratives to become ‘superficially egalitarian and emancipatory’ (Fraser, Reference Fraser2019: 13). As a structurally embedded, universal and socially influential yet disparate set of institutions, HEIs and universities have played an important role as part of this market-based hegemonic bloc. Once radical yet ultimately marginalised concepts such as equality, social justice, participation or anti-discrimination have been actively adopted by university sectors and welfare professional groups. This is despite each often being rebranded and diluted into more politically amenable and conservative forms. Recent examples within academic and policy discourses include those built around inclusion, participation, anti-oppression, empowerment, wellbeing and equality. Such constructs may mask or conceal different agendas, outcomes or projects, which might include new forms of age-related inequality or social exclusion in community-based settings.

Participation narratives, for example, regularly maintain a positive image that promotes democratic engagement, empowerment and inclusion for service users such as older adults, who, within Fordist welfare systems, were previously ignored (Cowden and Singh, Reference Cowden and Singh2007; Brett et al., Reference Brett, Staniszewska, Mockford, Seers, Herron-Marx and Bayliss2010; Hafford-Letchford and Formosa, Reference Hafford-Letchford and Formosa2016). Nevertheless, through the ideological prism of progressive neoliberalism, user involvement or related public consultation exercises can be used as social technologies of legitimation to achieve other agendas. Such ideological schemes have included the aggressive expansion of markets and private-sector provisions within health and social care since the 1980s, alongside welfare professional behavioural interventions disseminated through a participation hegemony which promotes active citizenship and responsible subjects (Clarke, Reference Clarke2004; Levitas, Reference Levitas2005; Kemshall, Reference Kemshall2010; Fenwick and McMillan, Reference Fenwick and McMillan2012). For example, patient involvement and participation in decision-making has been ever present as part of ‘liberal’ professional and research community narratives and documentation within institutions such as the National Health Service (NHS). Nevertheless, evidence suggests that staff still tend to control most staff–stakeholder interactions or core decision-making in activities such as care provision or research, and older people can be susceptible to institutionally based control (Gilleard and Higgs, Reference Gilleard and Higgs2000; Levitas, Reference Levitas2005; Fenwick and McMillan, Reference Fenwick and McMillan2012). Among others, Fenwick and McMillan (Reference Fenwick and McMillan2012), Scott-Samuel and Smith (Reference Scott-Samuel and Smith2015) and Daly and Westwood (Reference Daly and Westwood2018) note the popularity of cost-saving policy packages such as those built around participation or asset-based care by neoliberal governments, alongside their relative appeal to welfare professions or local government officials. Despite popularity, such policy initiatives are rarely able to confront significant power differences, reverse material inequality or reduce any structured dependency experienced by older people. Indeed, they may ironically extend each by helping to justify further professional powers or policies which intensify types of age-related exclusion.

Another distinguishing trait of the neoliberal university remains its capacity to focus upon presenting a positive image. This can include drawing influence from the practices of big business and marketing on how to present or market its services and products to potential consumers (Ball, Reference Ball2012; Morrissey, Reference Morrissey2015; Acker and Wagner, Reference Acker and Wagner2019). This may, for example, influence how professional training, practices or policy-orientated research is constituted and presented. A central part of social work education and later practice, for example, remains its commitment to anti-discriminatory and anti-oppressive practice. Alongside a socially just understanding of the impact of priority forms of exclusion such as racism, sexism or disablism, social workers are expected to provide at least some evidence that they are committed to fighting ageism in all its different forms (McLaughlin, Reference McLaughlin2005; Baines, Reference Baines and Williams2016). Among others, McLaughlin (Reference McLaughlin2005) has expressed significant doubts about the sincerity of these altruistic claims. Far from challenging the oppression of social excluded groups, McLaughlin instead argues that anti-oppressive training for social workers remains politically detached from its radical origins of the 1960s and 1970s, serves professional interests, and has become institutionalised within universities and practice settings, so as to allow the state ‘to reposition itself once again as the benign provider of welfare’ (McLaughlin, Reference McLaughlin2005: 283, 300). Moreover, through an essentially liberal-humanist discourse that dematerialises inequality, pedagogues morally condition students on themes such as the importance of using appropriate non-discriminatory language rather than highlighting structural forms of exclusion or poverty. Subsequently, in later casework-orientated praxis the role of any macro-structurally determined influences of society can be lost and oppression is instead identified as being ‘due to the moral failings of service users who need censure and correction from the anti-oppressive social worker’ (McLaughlin, Reference McLaughlin2005: 283, 300). Other theorists have highlighted the utilisation of pervasive consumer-based constructs including empowerment, asset-based care and participation to instil a micro-disciplinary ethic of self-help, personal responsibility and resilience for older citizens, including to discourage reliance upon ever-diminishing formal welfare state provisions (Gilleard and Higgs, Reference Gilleard and Higgs2000; Powell, Reference Powell2012; Rose and Abi-Rached, Reference Rose and Abi-Rached2013; Daly and Westwood, Reference Daly and Westwood2018).

Neoliberal social work, education and older people

Since the 1980s, neoliberal-inspired social work and social care have expanded throughout the UK, and in many other European countries, as elsewhere, such as in Canada, Australia and parts of South America (Ferguson et al., Reference Ferguson, Lavalette and Whitmore2005; Grassi and Alayon, Reference Grassi, Alayon, Ferguson, Lavalette and Whitmore2005). The formation of quasi-markets of health and social care has encouraged an enduring reduction of direct state support, alongside the rapid growth of private- (and initially some voluntary) sector provisions including residential, nursing and domiciliary social care (Lymbery, Reference Lymbery2010). A discourse built around a narrative of market-infused constructs has flourished, and included precedence given to autonomy, choice, purchaser/provider splits, wellbeing, stakeholder participation, user empowerment, performance, among other examples (Clarke, Reference Clarke2004; Jordan and Drakeford, Reference Jordan and Drakeford2012; Baines, Reference Baines and Williams2016). Within a rapidly expanding yet often poorly funded and fragmented ‘social work business’, contact between older ‘service users’ and ‘care managers’ became formal and brief, with focus built around the rationing of finite resources and the bureaucratic monitoring of eligibility for support (Harris, Reference Harris2003: 41–46; Ferguson, Reference Ferguson2007; Lymbery and Postle, Reference Lymbery and Postle2010). Provision within social care now chiefly targets the quantification of potential risks among ‘fourth agers’, meeting higher-level health care-related needs, or providing limited physical care or partially responding to safeguarding concerns (Dustin, Reference Dustin2007; Means, Reference Means2012; Hall and Scragg, Reference Hall, Scragg, Hall and Scragg2012). In England, core legislation such as the NHS and Community Care Act 1990, and more recently the Health and Social Care Act 2012 and Care Act 2014, have further normalised competition, rationing and privatisation within social care (Glynos et al., Reference Glynos, Speed and West2015: 63–64). In practice, a progressive market hegemony has fused with other professional and pedagogical narratives – including geriatric medicine and traditional forms of social work – to construct a compelling and seemingly legitimate risk-averse discourse. Despite the profuse language of empowerment, wellbeing, equality and anti-oppression, older people are often interpreted through bureaucratic health and social care classification systems and risk-averse discourses as representing a cost, threat or burden (Tomkow, Reference Tomkow2018).

Although market-led reforms and ‘austerity’ programmes have restricted much purposeful social work provision during the past three decades, the marginalisation of social work with older people has a much longer history. Despite representing the fasting growing user group, studies of social work practice have often supported a view of older people as a low priority or nuisance. This includes a commonplace professional view that real social work takes place with children and families, and that older people should be reserved for the attention of unqualified staff or volunteers (Phillipson, Reference Phillipson1982: 104; Hall and Scragg, Reference Hall, Scragg, Hall and Scragg2012). Geyer and Louw's (Reference Geyer and Louw2020: 93) recent survey-based research with 395 social work students notes that common reasons given for the limited interest in working with older people includes ageism; inadequate knowledge about later-stage ageing; assumptions that work with children is much more complex, meaningful and rewarding; and that working with older people is assumed to be ‘not challenging or rewarding’. Other studies have noted that social work students can assume that communication with older people is likely to be difficult; or that apparently commonplace problems such as poverty, loneliness, frailty or a lack of support provided will provoke either depression or feelings of guilt (Phillipson, Reference Phillipson1982; Hall and Scragg, Reference Hall, Scragg, Hall and Scragg2012; Geyer and Louw, Reference Geyer and Louw2020). Despite this, all students on taught programmes in universities (and which supply most qualified social workers in the UK) will have an option to specialise in work with older people, and much generic taught material is still intended to be valid for all ‘service user’ groups.

As part of an eagerness to regulate social work education and practice – and more generally reduce welfare provision through policy and law – Gwilym (Reference Gwilym2018) argues that the Coalition and Conservative governments in the UK have since 2010 neglected areas such as gerontological social work. Focus through ‘protectionist language’ has instead been given to safeguarding among children in need of care, and ‘it is here that the real drive for raising standards will take place reflecting political and media imperatives about this highly visible field’ (Gwilym, Reference Gwilym2018: 410). Within social work education itself, related reforms have included much longer periods of time spent on practice placements and less time given to study or teaching on campus. Moreover, course content relating to sociology, social policy or critical psychology has been significantly reduced as part of more standardised taught curriculums (Jones, Reference Jones and Parton1996). These reforms have occurred alongside the elevation of technical, competency, capability and skills-based training: all of which seemingly help to develop practitioners who will ‘not ask “difficult” questions, and therefore are easier for managers to manipulate and control’ (Morely, Reference Morely and Webb2019: 438). Central to these changes is the influence of employers and related government policy, including ongoing reforms within and of university sectors (Jones, Reference Jones and Parton1996; Harris, Reference Harris2003; Morely et al., Reference Morely, MacFarlane and Ablett2017, Reference Morely, MacFarlane and Ablett2019). For example, in the UK since the 1970s, governments and the now defunct Central Council on Education and Training in Social Work argued for much closer partnerships between universities and local authority employers. Since then, employers’ influence and direct control has grown significantly, including to a point where they now increasingly fund and lead university-based social work training. Such reforms have, nevertheless, often faced criticism. Partnerships, for example, are viewed as being much more about instilling student compliance to procedure, the law and government policy, including by encouraging social workers to accept the principle of a market-driven society and related inequalities (Dominelli, Reference Dominelli1997; Orme, Reference Orme and Lishman2012; Morley et al., Reference Morely, MacFarlane and Ablett2017). Morley et al. (Reference Morely, Ablett and Stenhouse2019: 141–149) argue that ‘technicist education’ within social work now prioritises ‘repetitive, linear and formulaic’ training for practice, which is dominated by audits, form-filling, and the careful control of finances and narrowly focused casework.

A cultural shift has also taken place, with numerous empirical studies suggesting that many social work students and younger practitioners now fail to acknowledge the impact of structural factors upon service users. Indeed, many seem to instead accept the validity of ‘hegemonic practices focused on behaviour, protection and risk assessment rather than help, welfare and advocacy’ (Fenton, Reference Fenton and Webb2019: 451). Davies and Leonard add further political context when they conclude that as an aspiring profession keen to impress neoliberal governments, social work endeavours to prove it is capable of embracing scientific knowledge and technical skills, so as to play ‘an important role in the monitoring and control of problematic populations’ (Davies and Leonard, Reference Davies and Leonard2005: x). Subsequently, much greater focus in education, research, training and practice is now placed upon paradigms and methodologies that fit closer to minimalist risk-averse policies or interventions. Notable examples include behavioural psychology, attachment theory, biomedical perspectives, functionalist sociology, systems theory and related models of practice, evidence-based perspectives, and so on.

Overuse of any such reductive paradigms have nevertheless faced criticism. For example, Estes et al. (Reference Estes, Biggs and Phillipson2003) note how an ongoing obsession with scientific objectivity in welfare professional roles will often limit any grasp of complex historical explanations or other perspectives for older people. This can depoliticise professional narratives whilst buttressing economic ideals such as rational choice (usually presented as autonomy within professional ethics), efficiency or performance, and allow complex events to be ‘colonized by exclusively professional understandings of adult ageing’ (Estes et al., Reference Estes, Biggs and Phillipson2003: 79–80). Overreliance upon biomedical or health-care research into dementia can also promote a specific focus upon randomised trials, quantitative methodologies or service evaluations, with the social complexity or human impact of a chronic condition which counters essentialist analysis becoming discursively marginalised. Some of these trends have been shared across associate welfare ‘helping professions’ (Estes et al., Reference Estes, Biggs and Phillipson2003: 80–81, 95). Tomkow (Reference Tomkow2018: 695–699), for example, draws from Foucault's concept of biopower to argue that in the UK frailty now represents an omnipresent ‘truth discourse’ which is embedded in biomedical knowledge, professional training and clinical praxis. Within medicine and health care this helps to fortify the professional control of older people, and further augments an ever-more dominant political narrative that the growing ageing population represents ‘an economic threat to the current configuration of health care in the UK’ (Tomkow, Reference Tomkow2018). Discursive attention is again drawn away from the impact of market-driven structural inequalities and instead moves towards responsibilities which are to be managed by older people or their families (Tomkow, Reference Tomkow2018: 695–699).

Personalisation and older people

Few policies within formal care embody the political contradictions and tensions embedded in permissive neoliberalism more than personalisation for older adults. Training for social workers in the UK, as elsewhere, has for some time included a strong emphasis placed upon personalisation, person-centred care and associate initiatives including participation and asset-based care. However, the role of adult social workers was originally intended to be minimal due to assumptions that older adults could join younger disabled people and lead what was politically envisaged as the archetypical consumer-based model of self-directed care (Lymbery, Reference Lymbery2014). Strong emphasis, for example, was placed upon service user-defined needs and self-organised care rather than developing professional roles in determining assessments of need or care provided. Markets of care, rational choice, autonomy and empowerment were intended also to replace the symbiotic role of local authorities and welfare professionals as seemingly remote institutions and faceless gatekeeping mandarins who served their own professional interests whilst promoting dependency among clients (Social Care Institute for Excellence (SCIE), 2012; West, Reference West2013; Woolham and Benton, Reference Woolham and Benton2013).

Personalisation policy has been supported by consecutive Labour, Coalition and Conservative governments within the UK, and first emerged in England in 2005. The policy pledged that independent living, person-centred planning and self-directed support – such as with personal budgets, direct payments, and associated information or advice if required – would replace any previous ‘one-size-fits-all’ universal social care provision. Relevant guidelines claimed to offer more independence, flexibility, choice and control for empowered community-based service users who required social care support, and this included more opportunities to engage with activities such as leisure (SCIE, 2012). For example, at the time of writing, on the government-funded SCIE's Social Care Online website there remains a publication entitled Personalisation: An Easy Read Guide (SCIE, 2012). This 20-page summary includes 48 pictures of smiling and laughing disabled and older people engaged in a variety of social activities which include active learning, the playing of games, drinking of wine, group walking, and so on. Alongside positive imagery the summary details how personalisation will reify service users to ‘engage more socially’, ‘travel around’, ‘learn new things’ and ‘have fun’ (SCIE, 2012: 3–15).

Although emphasis was initially placed on users ‘having a say’ about ‘the services which would work best for them’ (Gray and Birrell, Reference Gray and Birrell2013: 80–81), scarce financial resources quickly meant that focus was instead built around more traditional means-tested services such as domiciliary, day and residential care provision (Means, Reference Means2012; Lymbery, Reference Lymbery2014). The document Putting People First had earlier highlighted the apparent strains of a rapidly ageing population, the growth of more complex communities and stressed a pressing need to ‘explore options for the long-term funding of the care and support system’ (Department of Health, 2007: 2–5). As with subsequent legislation and policy, including the Care Act 2014, use of progressive terminology and slogans drawn from disability rights campaigns were presented within care-related institutions and publications. Putting People First, for example, argued that staff were to be involved ‘in the cutting edge of innovation’, and older people represented ‘participants in the change program’ and were pivotal to ‘engagement’, ‘choice’ and a ‘shared commitment to social justice’. Similarly, the Care Act 2014 has emphasised the importance of ‘maximizing personal choice’ and ‘person-centred planning’ for older users, and highlights that support ‘should be holistic and empowering’ (Barnes et al., Reference Barnes, Boland, Linhart and Wilson2017: 176–180). In contrast to earlier legislation, the Care Act has also given more attention to encouraging service users, unpaid carers, family members and wider community groups, to draw actively from their ‘assets’ and ‘participate’ more in supporting themselves. Professionals such as social workers, health and other care workers are encouraged to inspire self-directed, ‘asset-based’ or ‘strengths-based’ support.

Numerous critics have continued to highlight the prevalence of more consistent political themes which challenge the cross-party development of personalisation. For example, on behalf of Age UK, Feltoe and Orellana (Reference Feltoe and Orellana2013) draw from a wide range of empirical studies to evaluate the impact of personal budgets as part of personalisation policy for older people in receipt of social care support. While they accept the potential of personalised care to improve support for older adults, numerous gaps and inconsistencies regarding overall provision are highlighted. This includes often alarming differences of support available geographically and among specific user groups. Overall, personal budgets also appear to be failing to meet many of the needs of older adults:

It is also noted that if eligible for support, personalised care and payments can be difficult for many older people to manage, and may, ironically, make users more emotionally or physically dependent on their family or other carers. Evidence has also stressed the inequalities which can emerge around mental capacity, or physical or psychological frailty, especially if support from family or friends is not readily available (Glendinning et al., Reference Glendinning, Challis, Fernandez, Jacobs, Jones, Knapp and Wilberforce2008). Moreover, if able to access finite personalised care, most older people are much more likely subsequently to face an unexpected deterioration in health or other crisis. Therefore, an expectation of organising care with limited support is either largely unattainable or will represent either a significant challenge or risk. In addition, personalisation and self-directed care will not untypically privilege more educated families (Ferguson, Reference Ferguson2007; Woolham and Benton, Reference Woolham and Benton2013).

Evidence also suggests that personalisation can fortify traditional ageist assumptions, not least by local authorities placed in charge of assessments and eligibility to receive care or not. In Feltoe and Orellana's (Reference Feltoe and Orellana2013) appraisal of studies, priority had often been given to younger disabled adults, with insufficient information made available to older people. Service users who were frail, required ‘end-of-life’ care or who had conditions such as dementia were regularly excluded from the option of personalised care, despite these groups more often representing the people most likely to meet higher eligibility criteria to receive funding towards providing health or social care provision. Despite its popularity with governments and professional groups, this brings into question the feasibility of the policy for most older people likely to be eligible. For older adults, rather than younger people, there were also far fewer resources made available, and greater emphasis was placed on providing personal care rather than endorsing the use of social or leisure activities.

Within many studies budget restrictions due to austerity policies pursued within the UK since 2008 had severely limited available resources and options to finance social care support. Rabiee et al. (Reference Rabiee, Baxter and Glenndining2016) drew from interviews with 34 social care staff across three local authorities in England and discovered that most older people receiving domiciliary care preferred not to manage their own support, and tended instead to allow a local authority or service provider to manage both their budget and care. Choice and control were severely restricted or not evident for older people, which was further compromised by ‘resource constraints, new communication barriers, restrictions on the use of managed personal budgets and inadequate training for practitioners’ (Rabiee et al., Reference Rabiee, Baxter and Glenndining2016: 464–467). Brooks et al. (Reference Brooks, Mitchell and Glendinning2017) interviewed ‘personalisation lead officers’ for older and disabled people across 16 adult social care departments in two authorities in England. The authors examined personalised support for informal carers and service users yet highlighted ‘fragmented and inconsistent’ practices on behalf of local authorities (Brooks et al., Reference Brooks, Mitchell and Glendinning2017: 152–162).

As an early critic, Ferguson (Reference Ferguson2007) argued that personalisation policy maintained a strong association with New Labour's repeated use of ‘warmly persuasive words’: notably highlighting ‘empowerment’ and ‘partnership’ as key ideological terms used to extend market-driven welfare reforms. As well as expanding use of the core market values of individualisation and autonomy, personalisation has also increased responsibility on behalf of service users, and developed further ‘the privatisation of risk’ from the state to older people and their families. Further reforms have included the deskilling and further marginalisation of any positive social work role and denial of the influence of poverty and inequality upon user groups or carers working with adults (Ferguson, Reference Ferguson2007: 388–397). Ferguson also highlights the political use of personalisation policy to again expand business opportunities for the private sector. For example, call centres for social work in England and Australia have expanded as part of the personalised care policy, with British Telecom in the UK notably benefiting from much greater involvement in social care provision than before. Such call centres, however, can mean that service users have no direct contact with social workers, and they can be used to prompt older people or their carers to seek help elsewhere.

When drawing upon interviews with 50 adults and older people with fluctuating support needs and/or experiencing a deterioration of health, Rabiee (Reference Rabiee2013) again highlights the not uncommon complexities of choice and independence for service users. The research highlighted the ‘multi-dimensional nature’ of the concept of independence, including that independence tends to be contextually variable, and that the relationship between choice and independence for older and disabled people is ‘not always as simple and linear as choice policies assume’ (Rabiee, Reference Rabiee2013: 881–885). Sothall et al. (Reference Sothall, Lonbay and Brandon2021) draw from data gathered as part of two PhD studies into the experiences of adult social workers based in the North-East of England. Echoing numerous other studies, they acknowledge the potential of personalisation to promote independence, and recognise some users who had benefited from such new practices, but numerous challenges were again central to their critical findings and analysis. This included the ‘liminal space’ negotiated by practitioners stood between an idealised consumer-based policy and numerous ‘structural barriers’ faced by both users and practitioners (Sothall et al., Reference Sothall, Lonbay and Brandon2021). Briefly, they conclude that the consumer-model of personalised care significantly understates the diverse needs and precarious circumstances often experienced by most community-based older adult users (including safeguarding related), as well as the enduring paradox of any relative dependence on others to make the policy work.